Daily on Healthcare: What the healthcare industry wants from Congress: More money for Obamacare

What the healthcare industry wants from Congress: More money for Obamacare. House Democratic leaders are swiftly moving legislation to shore up Obamacare, saying they have a mandate from voters to fight back against the Trump administration’s “sabotage” of the healthcare system.

The proposals they are weighing align neatly with the desires of the healthcare industry by injecting billions of federal dollars into Obamacare. While they’re likely to lower what patients pay for coverage and to boost insurance rates, they include no measures to control overall healthcare spending.

House leaders have said they would be open to other, more sweeping healthcare proposals once they are satisfied that Obamacare’s exchanges are stabilized, but liberal Democrats who support the Medicare for All Act view the U.S. healthcare system as broken far beyond the problems facing Obamacare. An aide to Sen. Bernie Sanders, I-Vt., who is running for the presidency and is a longtime champion of government healthcare, said fixes to Obamacare were okay for now, but the calculation would be different if a Democratic president were to be elected. “We can’t tell them to wait around until you have Democrats in control of everything,” the aide said. “But if Democrats do have control, we have to think about what our actual plan is to fix the healthcare system.”

Just hours after the formal introduction of the Medicare for All Act, the 101-member New Democrat Coalition urged the caucus to focus first on shoring up Obamacare with billions of dollars in federal funding, calling it more pragmatic. The plan is similar to an Obamacare stabilization package that failed last year in the Senate after Democrats objected to its anti-abortion language. Democrats have been unable to say how they would work around that impasse in pursuing the policy again, and GOP leaders have shown little interest in revisiting Obamacare. This means a proposal to shore up Obamacare might have to wait for a Democratic president after all.

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How Trump would cut Medicare by $818B in a decade. President Trump’s proposed budget released Monday appeared to call on Congress to cut $818 billion from Medicare over 10 years, despite a long-standing promise from the president that he wouldn’t touch the popular program. The budget does not outline specific cuts to Medicare, nor does it propose a cost-saving plan along the lines of an idea from former House Speaker Paul Ryan, R-Wis., to give beneficiaries subsidies to buy private coverage. Instead, the budget envisions spending reductions through Congress passing prescription-drug legislation and through efforts to reduce improper payments to healthcare providers. “He’s not cutting Medicare in this budget,” Russell Vought, acting director of the Office of Management and Budget, said at a White House press briefing Monday. “What we are doing is putting forward reforms that lower drug prices, that, because Medicare pays a very large share of drug prices in this country, has the impact of finding savings. We are also fighting waste, fraud, and abuse.”

Here’s where the cuts come from. The budget sees prescription drug reforms yielding $69 billion in savings, though some of the policies would require Congress to pass new laws. Ideas include banning high-cost brand name drugs from keeping generics off the market, negotiating the cost of drugs patients get at the hospital or in a doctor’s office, and approving generics faster. The budget also proposes to reduce what Medicare pays doctors and hospitals. Roughly $6.4 billion in savings would come from reducing fraud, waste, and abuse.

Democrats expected to weaponize the Medicare cuts. While the cuts to Medicare Trump proposed wouldn’t result in direct cuts in patients’ benefits, the proposals are likely to become a central line of attack for Democrats as they gear up to fight Trump in 2020. People on Medicare, the majority of whom are 65 and older, make up a large cohort of Trump supporters. “From a pure political perspective, this is — by far — the most radical, unpopular proposal that any 2020 candidate had put forward thus far,” tweeted Jon Favreau, a speechwriter for former President Barack Obama. “Every Democrat should be talking about this every day. Start running the ads now and don’t stop until Election Day.”

The more significant cuts would be enacted to Medicaid. The budget requests rolling back Obamacare’s expansion of Medicaid and instead converting the program to a block grant in which states would get more say in how the money is spent. It also wants people on Medicaid to pay co-pays if they go to the emergency department for a non-emergency need, and it would impose work requirements in exchange for coverage. The changes would reduce Medicaid spending by $241 billion.

Trump proposes subjecting e-cigarette makers to FDA user fees. The Trump administration proposed charging user fees to e-cigarette makers in its fiscal year 2020 budget released Monday, hoping to stop what outgoing Food and Drug Administration Commissioner Scott Gottlieb has called “an epidemic” of tobacco use among young people. The proposal would add e-cigarette manufacturers and importers to the list of companies required to pay user fees to the FDA, and raise the amount of user fees that companies could be required to pay. Traditional tobacco companies already pay the fees. The change “would ensure that FDA has the resources to address today’s alarming rise in youth e-cigarette use as well as new public health threats of tomorrow,” the budget proposal said.

Trump budget chief promises to spare training programs from cuts to boost welfare work requirements. Acting Trump budget chief Russ Vought said Monday that the administration would provide ample funding for federal job training programs if Trump’s planned work requirements for welfare go into effect. “There will be many workforce development programs funded as a result of this budget,” Vought said during a White House press briefing, though he did not go into specifics. Trump’s budget for fiscal year 2020 proposes expanded work requirements for federal assistance programs. Earlier, Vought noted that the budget provides for hardship exceptions to the requirements, which would apply to food stamps, cash welfare, housing assistance, and Medicaid.

Insulin makers get back to Congress. Eli Lilly, Novo Nordisk, and Sanofi — the three companies that make insulin — have responded to a Senate Finance Committee inquiry about the prices increases on their drugs. The Finance Committee isn’t making the details of the correspondence public just yet, however. “The committee is reviewing the responses and looks forward to additional productions in a timely fashion,” said Michael Zona, spokesman for the committee. “The bipartisan investigation is ongoing and any findings will be released when appropriate.” Senators had asked how list prices were determined, as well as information on research and development, marketing, and revenues.

People are using fewer healthcare services but health spending is still going up. That’s according to a new online healthcare tool from the Health Care Cost Institute funded by the Robert Wood Johnson Foundation, which shows the use of healthcare services is down 17 percent even though spending is up by roughly 13 percent. The tool examined how often people used healthcare services from 2012 to 2016 and how much they cost per transaction. It found significant variation across and even within metro areas. The tool lets users compare healthcare prices and use in 112 areas in 43 states.

‘Club drug’ variant wins FDA approval. A variant of the chemical ketamine, esketamine, has found a third incarnation as an antidepressant nasal spray from Janssen, the pharmaceutical division of the health-products giant Johnson & Johnson that won approval March 5 from the Food and Drug Administration. Developed in the early 1960s, ketamine first gained popularity as a battlefield anesthetic for wounded soldiers. By the mid-1980s, it had achieved a second life as a club drug, due to its trippy, psychedelic effects. Because of its history and the potential for abuse, the FDA approved its use only for people with treatment-resistant depression, those who have tried at least two other antidepressant medications without success. Each spray — marketed under the brand name Spravato — must be administered in medical offices where healthcare personnel can monitor reactions for at least two hours, and patients aren’t allowed to take it home, according to Janssen and the FDA.

Border Patrol diverted $45M in operations budget to cover migrant healthcare costs. The Department of Homeland Security has diverted $45 million in operational funds to go toward medical costs over the past five years, according to data obtained by the Washington Examiner. The U.S. Border Patrol has diverted $9 million in operational funding in fiscal year 2019, as it has done in each of the four previous years, to cover medical screenings and related services for thousands of immigrants. The Border Patrol began transferring the money at the beginning of fiscal year 2015, just as record-high numbers of unaccompanied minors were arriving at the southern border. The Border Patrol entered into a Medical Services Blanket Purchase Agreement with a contract medical provider in fiscal 2015. The agreement included screenings and referrals to specialists when necessary. Patients who needed additional medical help were sent to a local medical treatment facility, which was included in the $9 million.

The Rundown

Axios Lawsuit says Johnson & Johnson was opioid “kingpin”

NPR Fresh challenges to state exclusions on transgender health coverage

Modern Healthcare Healthcare workers face violence ‘epidemic’

Kaiser Health News Trump’s budget offers $291M to fight HIV in U.S. but trims overseas efforts

The Associated Press Trump budget proposal counts on optimistic growth, deep cuts

The Washington Post This HIV pill saves lives. So why is it so hard to get in the Deep South?

Calendar

TUESDAY | March 12

10 a.m. 2154 Rayburn. House Committee on Oversight and Reform hearing on “Examining the Public Health Risks of Carcinogens in Consumer Products.” Details.

10 a.m. National Press Club. 529 14th St. NW. VA Secretary Robert Wilkie and Sanford Health CEO Kelby Krabbenhoft to announce precision medicine partnership. Details.

10:15 a.m. 2175 Rayburn. House Education and Labor Committee Subcommittee on Civil Rights and Human Services hearing on “Growing a Healthy Next Generation: Examining Federal Child Nutrition Programs.” Details.

Noon. 2123 Rayburn. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the House Energy and Commerce Committee. Details.

WEDNESDAY | March 13

March 13-16. American Bar Association 20th Annual Emerging Issues in Healthcare Law Conference. Agenda.

March 13-14. America’s Health Insurance Plans health policy conference. Agenda.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Lowering the Cost of Prescription Drugs: Reducing Barriers to Market Competition.” Details.

2 p.m. 2358-C Rayburn. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the House Appropriations Committee. Details.